White Survivors Research Articles

Material and behavioral financial hardship as predictors of health-related quality of life in a diverse cohort of cancer survivors.

145 Background: Financial hardship is common among cancer survivors, but its association with health-related quality of life (HRQOL) unknown. Methods: We utilized data from 570 black participants the Detroit Research on Cancer Survivors (ROCS) cohort study diagnosed with breast, colorectal, lung or prostate cancer since 1/1/13 and diagnosed or treated at the Karmanos Cancer Institute, and 402 white survivors meeting the same criteria. HRQOL was measured using the functional assessment of cancer therapy-general (FACT-G) and its subscales of physical, social, emotional and functional wellbeing, and site-specific measures. We fit linear regressions to estimate associations between material (debt, borrowing, selling assets, reduced income) and behavioral (skipping medication, not seeing a doctor, refusing treatment due to cost) financial hardship (MFH and BFH, respectively) and HRQOL. Adjusted models include demographic, socioeconomic, and treatment-related factors. Results: Overall, 50.3% of participants experienced material and 17.6% experienced behavioral financial hardship. In unadjusted models, HRQOL scores were 0.39 (95% CI 0.27, 0.51) standard deviations (SD) lower in those reporting any MFH. MFH was associated with significantly lower physical, emotional, and functional wellbeing scores, and with lower scores on breast-, colorectal-, and prostate-specific HRQOL measures. Total HRQOL was 0.68 SD (95% CI 0.52, 0.84) lower for participants who reported BFH than those who did not, and BFH was inversely associated with each subscale and each cancer-specific measure. In adjusted models, HRQOL scores were 0.15 (95% CI 0.03, 0.27) SD lower among participants reporting MFH and remained inversely associated with physical and functional wellbeing. BFH was associated with 0.42 (95% CI 0.27, 0.57) SD lower HRQOL scores and remained inversely associated with physical, social, emotional, and functional wellbeing; and with breast- and prostate-specific measures. Conclusions: MFH and BFH are associated with lower HRQOL among diverse cancer survivors. Addressing BFH in particular may improve HRQOL among survivors, particularly those with breast and prostate cancer.

Three Year Functional Trajectories Among Old Age Survivors and Decedents: Dying Eliminates a Racial Disparity.

Long-term trajectories of disability comparing decedents and survivors and differences by race have not been assessed. To examine self-reported difficulty in walking a quarter mile and the need for assistance with activities of daily living (ADL) beginning 3years before death among decedents and age- and gender-matched survivors. A case-control sample drawn from the Health, Aging and Body Composition Study (Health ABC). Data were collected between 1997 and 2015. Of the 1991 participants who died by the end of the study, 1410 were interviewed for 3years prior to death, including an interview 6months before dying. Of these, 1379 decedents were successfully matched by age and gender with 1379 survivors and tracked over the same 3-year period. Self-reported difficulty walking a quarter mile and the ability to perform activities of daily living without assistance (bathing, dressing, transferring). Decedents (mean age at death, 84) increased in mobility disability from 44.1% 3years before death to 69.4% 6months before death and in ADL disability from 32.9% to 58.4%. Among survivors, mobility disability increased from 31.4% to 40.7% and ADL disability from 17.4% to 31.4%. The proportion of decedents and survivors with mobility disability differed significantly in adjusted models at all assessment points (p < 0.0001). African-American survivors were significantly more disabled than White survivors at all points (p < 0.0001), but trajectories of disability among decedents did not differ by race in the last 18months of life (p = 0.35). Trajectories of self-reported disability differ between survivors and decedents. Older adults who died were more disabled 3years before death and also had a greater risk of increasing disability over each subsequent 6-month assessment. The gap in disability between African Americans and Whites was erased in the final 1 to 1.5years before death.

Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors.

Whether cardiovascular disease (CVD) risk differs according to race and cancer type among survivors of childhood or young adulthood cancers is unknown. Data from the years 1973-2011 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) registries. Cases were categorized by ICD-0-3/WHO 2008 Adolescent and Young Adult classification. CVD death was determined by ICD-10 codes for diseases of the heart, atherosclerosis, cerebrovascular diseases, or other diseases of the arteries. Cox proportional hazards models were fitted to evaluate the hazard ratio (HR) and 95% confidence intervals (CIs) for the effects of race on time-to-event outcomes. A total of 164,316 cases of childhood and young adult primary cancers were identified. There were 43,335 total and 1466 CVD deaths among Black and White survivors. Black survivors had higher risks of all-cause mortality (HR: 1.75, 95% CI: 1.70-1.7) and CVD mortality (HR: 2.13, 95% CI: 1.85-2.46) compared to White survivors. The increased risk of CVD for Black survivors compared to White survivors persisted at 5-years (HR: 2.38, 95% CI: 1.83-3.10), 10-years (HR: 2.59, 95% CI: 2.09-3.21), and 20-years (HR: 2.31, 95% CI: 1.95-2.74) postdiagnosis, and varied by cancer type, with the highest HRs for melanoma (HR: 8.16, 95% CI: 1.99-33.45) and thyroid cancer (HR: 3.43, 95% CI: 1.75-6.73). Black survivors of childhood or young adulthood cancers have a higher risk of CVD mortality compared to Whites that varies by cancer type. Knowledge of at-risk populations is important to guide surveillance recommendations and behavioral interventions. Further study is needed to understand the etiology of racial differences in CVD mortality in this population.

Understanding Breast Cancer Survivors' Beliefs and Concerns About Adjuvant Hormonal Therapy: Promoting Adherence.

Adjuvant hormonal therapy is recommended for women with hormone receptor (HR)-positive breast cancer. Though critical, many patients are non-adherent to this therapy. Few scales have been developed to specifically address beliefs about adjuvant hormonal therapy. This study explores the clarity and relevance of the Beliefs about Medicine Questionnaire (BMQ) in the context of adherence behaviors to hormonal therapy in Black and White breast cancer survivors. We recruited women diagnosed with HR-positive cancer from the Washington, DC, area. An interviewer administered a standardized survey and conducted a cognitive interview. Participants rated the BMQ across three areas: relevance, difficulty, and clarity. We coded whether the comments identified item level issues: limited applicability, unclear reference, unclear perspective, or wording or tone. In-depth interviews were conducted with women who prematurely discontinued hormone therapy. The sample (n=30) was equally split between Black and White survivors. On average, women were 57.9years old (SD=9.0). Overall 77% rated scale as relevant. Cognitive interviews revealed areas of perceived limited acceptability such as the notion of becoming too dependent or the notion of becoming worse if not taking the medication. Women who discontinued hormonal therapy (n=2) felt ambivalent towards hormonal therapy as they reported having both positive and negative beliefs about the medication. Our study findings suggest new areas for further research and instrument development to accurately measure self-reported beliefs about hormonal therapy by HR-positive breast cancer survivors.

Abstract C13: How does the financial impact of cancer differ by race? Results from the Cancer Survivorship in Metropolitan Detroit cohort study

Abstract Background: Previous research suggests that financial burdens due to cancer are more common in African-American than white survivors, but it is not known whether or how the types of burdens experienced differ by race. Methods: This study utilizes preliminary data from the Cancer Survivorship in Metropolitan Detroit (CSMD) cohort. African-American and white adults ages 20-79 are eligible to join the cohort if they were identified through the Metropolitan Detroit Cancer Surveillance System as having been diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013 and were diagnosed and/or treated at the Karmanos Cancer Institute. To date, 695 (281 white, 414 African-American) of the targeted 1000 survivors have completed the baseline questionnaire online or over the phone. Data collected include demographic and socioeconomic characteristics, medical history, and financial burden measures including indicators of whether participants sold assets or borrowed money to pay for cancer care; limited care due to cost; experienced a decrease in income since diagnosis; and whether they are currently in debt due to cancer expenses. This abstract presents results of bivariate analyses and odds ratios (OR) and 95% confidence intervals (CI) from logistic regressions controlling for age, sex, treatment, and insurance. Results: Overall, 52.4% of survivors experienced some form of financial burden related to cancer, and prevalence was higher in African-American (56.6%) than in white survivors (46.3%; p=0.011). A marginally higher proportion of white (24.7%) than African-American survivors (19.2%; p=0.08) used existing assets to pay for cancer care, including higher proportions who withdrew money from savings (14.6% vs. 9.2%; p=0.027) or retirement accounts (7.8% vs. 3.4%; p=0.009). Although an identical proportion (9.8%) of white and African-American survivors borrowed money from family or friends, more African-American (31.2%) than white (18.1%; p&amp;lt;0.001) survivors were still in debt due to expenses related to cancer treatment. More African-American (21.3%) than white (14.6%; p=0.027) survivors also limited care due to cost concerns, including reporting that they needed to see a doctor in the past year but could not due to cost (15.1% vs. 9.1%; p=0.022) and that they skipped doses of prescribed medication to save money (8.8% vs. 5.4%; p=0.094). No differences were observed in the proportion of African-American and white survivors who sold stocks or other investments (1.2% vs. 2.1%), refused treatment due to cost (4.6% vs. 5.0%), or experienced a decrease in income due to cancer (30.2% vs. 27.3%). In adjusted analyses, African-American race remained associated with higher odds of being in debt due to cancer (OR: 2.09; 95% CI: 1.39, 2.14) and experiencing any form of economic burden (OR: 1.49, 95% CI: 1.04, 2.12) and marginally associated with skipping doses of prescribed medication (OR: 1.77 95% CI: 0.92, 3.42) and limiting care due to cost (OR: 1.46, 95% CI; 0.93, 2.28). Implications: These findings suggest that although large proportions of both white and African-American survivors experience some form of financial burden related to cancer, a larger proportion of white survivors may be able to utilize existing resources to pay for cancer treatment, while a larger proportion of African-American survivors experience lasting debt or forego necessary care due to cost concerns. As research into the economic consequences of cancer survivorship continues and expands into the development of interventions to reduce their impacts, it is important to identify not only disparities in the overall prevalence of economic burden, but also in the forms those burdens take for distinct groups. Citation Format: Theresa A. Hastert, Lauren M. Hamel, Tara Baird, Terrance L. Albrecht, Ann G. Schwartz, Michael S. Simon, Fawn Vigneau, Jennifer L. Beebe-Dimmer. How does the financial impact of cancer differ by race? Results from the Cancer Survivorship in Metropolitan Detroit cohort study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C13.

Abstract A55: Assessing the applicability of leventhal's common sense model of illness representation to explain african american prostate cancer survivors' disease experiences and disease Management Strategies

Abstract Background: Culture has a major influence on many aspects of health in general, and cancer prevention and control in particular. Culture influences the receptiveness of consensus and evidence-based risk reduction strategies across the continuum of care. Culture also provides men with templates for interacting with clinicians and the health care system. Over the past two decades, medical and public health practitioners have devoted a great deal of attention to understanding how African American culture influences the multi-level processes that create or maintain prostate cancer treatment disparities. The current study adds to this growing body of literature by exploring the usefulness of Leventhal's Common Sense Model (CSM) of Illness Representation to explain the content and structure of African American prostate cancer survivors' narratives of their disease process and disease management strategies. Narrative structure was evaluated using the five illness representation domains of the CSM (i.e., cause, control/cure, consequences, identity, and, timeline). Narrative content was explored using investigator created sub-themes representing each illness representation domain. Methods: A purposive sample of prostate cancer survivors was recruited via cancer registries, word-of-mouth and newspaper advertisements in New York and Georgia from 2013 to 2014. Survivors were eligible to participate if they were diagnosed with localized prostate cancer (T1 or T2), able to speak and understand English, and self-identified as African American. Each participant completed a semi-structured, in-depth interview with a graduate trained interviewer. All men provided written informed consent and received a $50 incentive for their participation. Each interview was audiotape recorded, transcribed verbatim by a professional transcriptionist and entered into MAXQDA12 software for data management and analysis. All transcribed interviews were coded independently by a three-member team until a minimum of 80% coding agreement was reached. Results: A total of 15 men completed in-depth interviews. All interviews lasted between 30 - 90 minutes. With regard to narrative structure, survivors provided descriptions characterizing all five of the illness representation domains. More survivors provided descriptions relating to causes and consequences, while fewer provided descriptions related to the timeline domain. With regard to coping, many interviewees reported that it was challenging to simultaneously develop a treatment care plan while managing their emotions. Most descriptions of the consequences centered around concerns men had related to treatment rather than having the disease. Several interviewees expressed concerns about limitations placed on their personal and social relationships as a result of treatment complications. With regard to emotional coping, men reported a variety of adaptive and maladaptive strategies including acceptance, avoidance, humor, religion, and shared decision-making with family members and significant others. Despite these concerns, most men were grateful to be alive and were optimistic about their prognosis. Conclusion: The results of this research suggest that the CSM can be used to explain African American prostate cancer survivors' experiences with treatment care planning and coping. Future research should elucidate culturally acceptable strategies to help men simultaneously develop treatment plans and deal with the emotional aspect of having this disease. Future research should also focus on identifying similarities and differences between African American and White survivors using the CSM to determine if unique or one-size-fits all interventions are sufficient. Citation Format: Jarrett Johnson, Sarbesh Pandeya, Ahmed Kabore, Levi Ross. Assessing the applicability of leventhal's common sense model of illness representation to explain african american prostate cancer survivors' disease experiences and disease Management Strategies. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A55.

Women With Breast Cancer Who Work For Accommodating Employers More Likely To Retain Jobs After Treatment.

Breast cancer affects one in eight women across the United States, and low-income minority survivors of breast cancer are at increased risk of job loss, compared to higher-income white survivors. Employer accommodations, such as schedule flexibility, have been associated with job retention in higher-income whites, but the role of such accommodations in job retention among low-income minorities is not well understood. We conducted a longitudinal study of 267 employed women ages18-64 who were undergoing treatment for early-stage breast cancer and spoke English, Chinese, Korean, or Spanish. We categorized patients by income level and by race/ethnicity. The category with the lowest job retention after treatment was low-income women (57percent). Job retention varied widely by race/ethnicity, ranging from 68percent among Chinese women to 98percent among non-Latina whites. Women who had accommodating employers were more than twice as likely to retain their jobs as those without accommodating employers. Low-income women were less likely than higher-income women to have accommodating employers, however. More uniform implementation of accommodations across low- and high-paying jobs could reduce disparities in employment outcomes among workers with a cancer diagnosis. Additional research is needed to better understand the barriers that employers, particularly those with low-income workers, may face in providing accommodations.

Absence of Basal Cell Carcinoma in Irradiated Childhood Cancer Survivors of Black Race: A Report from the St. Jude Lifetime Cohort Study.

Cancer survivors exposed to therapeutic radiation are at increased risk for basal cell carcinoma (BCC). Despite the notable influence of race on rates of BCC in the general population, the same is not clearly defined in previously irradiated cancer survivors. We investigated the influence of race on the development of BCC in adult survivors of childhood cancer. Using a retrospective cohort study, outcomes were collected through June 30, 2015, for 1,746 irradiated childhood cancer survivors participating in the St. Jude Lifetime Cohort Study (SJLIFE), comprising a total of 33,147 person-years of follow-up. Subsequent neoplasms identified in survivors through self-report and prospective clinical assessment were validated by pathology reports. Expected numbers of each type of radiation-associated neoplasm, including BCC, were calculated for irradiated black survivors based on rates in irradiated white survivors, accounting for primary cancer diagnosis, diagnosis year, attained age, and sex. On the basis of the rate of BCC in previously irradiated white survivors, 56.1 BCCs were expected among 237 black survivors, yet none observed. In contrast, the observed-to-expected ratio of non-BCC radiation-associated neoplasms (melanoma, brain, breast, thyroid cancer) was 0.88 (30 observed/34.2 expected, 95% confidence interval, 0.59-1.25). We identified an unexpected absence of BCC in irradiated black survivors in SJLIFE. We observe a similar absence of BCC in black individuals among two additional cohorts treated with irradiation for childhood cancer. Black survivors are at a substantially reduced or absent risk for BCC from therapeutic radiation for reasons not yet fully understood. Cancer Epidemiol Biomarkers Prev; 25(9); 1356-60. ©2016 AACR.

Post-treatment problems of African American breast cancer survivors.

African American breast cancer survivors (AABCS) have a lower survival rate across all disease stages (79%) compared with White survivors (92%) and often have more aggressive forms of breast cancer requiring multimodality treatment, so they could experience a larger burden of post-treatment quality of life (QOL) problems. This paper reports a comprehensive assessment of the number, severity, and domains of problems faced by AABCS within 5years after treatment completion and identifies subgroups at risk for these problems. A population-based random sample was obtained from the Pennsylvania Cancer Registry of African American females over 18years of age who completed primary treatment for breast cancer in the past 5years. A mailed survey was used to document survivorship problems. Two hundred ninety-seven AABCS completed the survey. The median number of survivor problems reported was 15. Exploratory factor analysis of the problem scale revealed four domains: emotional problems, physical problems, lack of resources, and sexuality problems. Across problem domains, younger age, more comorbid conditions, and greater medical mistrust were risk factors for more severe problems. The results demonstrated that AABCS experienced significant problem burden in the early years after diagnosis and treatment. In addition to emotional and physical problem domains that were documented in previous research, two problem domains unique to AABCS included lack of resources and sexuality concerns. At risk groups should be targeted for intervention. The study results reported in this manuscript will inform future research to address problems of AABCS as they make the transition from cancer patient to cancer survivor.

The psychosocial experiences of breast cancer amongst Black, South Asian and White survivors: do differences exist between ethnic groups?

Very little UK-based research has examined breast cancer-related experiences of Black and Minority Ethnic populations, and we do not know whether the psychosocial impact of diagnosis and treatment in this group is any different to that of White women. Therefore, this study examined similarities and differences amongst Black, South Asian and White breast cancer survivors. A quantitative, cross-sectional survey was conducted; 173 breast cancer survivors (80 White, 53 South Asian and 40 Black) completed a questionnaire, which assessed psychological functioning, social support, body image and beliefs about cancer. Significant differences (p < 0.05) were reported between White and South Asian participants: compared with White women, South Asian participants reported higher levels of anxiety and depression, poorer quality of life and held higher levels of internal and fatalistic beliefs pertaining to cancer. Black and South Asian women reported higher levels of body image concerns than White women, and held stronger beliefs that God was in control of their cancer. South Asian women turned to religion as a source of support more than Black and White women. This study enhances current understanding of the experience and impact of breast cancer amongst Black and South Asian women, and demonstrates similarities and differences between the ethnic groups. The findings highlight implications for healthcare professionals, particularly in relation to providing culturally sensitive care and support to their patients. Copyright © 2016 John Wiley & Sons, Ltd.

Prevalence and Predictors of Overweight and Obesity Among a Multiethnic Population of Pediatric Acute Lymphoblastic Leukemia Survivors: A Cross-Sectional Assessment.

As previous studies of obesity in survivors of pediatric acute lymphoblastic leukemia (ALL) have primarily been conducted among non-Hispanic white survivors or children treated on older protocols, our objective was to describe the prevalence and correlates of overweight status among an ethnically diverse population of pediatric ALL survivors, largely treated with more contemporary therapies. We evaluated the overweight/obesity status of pediatric ALL survivors (n=406) followed in the Texas Children's Cancer Center between 2004 and 2014. Survivors were classified as underweight, normal weight, overweight, or obese on the basis of their body mass index at their most current follow-up visit. Our results showed that Hispanic ethnicity (39% of the subjects) was associated with being overweight (adjusted odds ratio=1.88; 95% confidence interval, 1.13-3.14) or obese (adjusted odds ratio=2.84; 95% confidence interval, 1.59-5.06) at follow-up, even after adjusting for cranial radiotherapy (CRT) exposure. Body mass index z-score at diagnosis was also associated with overweight/obesity at follow-up. In addition, there was a statistically significant interaction between younger age at diagnosis and CRT, indicating that younger age at diagnosis was associated with obesity among patients who received CRT. These findings may help identify pediatric ALL patients that are at increased risk of being overweight or obese after treatment.

Great expectations: racial differences in outcome expectations for a weight lifting intervention among black and white breast cancer survivors with or without lymphedema.

Black breast cancer survivors are less likely to engage in physical activity than are White survivors. This is unfortunate because physical activity may be especially beneficial given Black breast cancer survivors' higher rates of obesity and adverse treatment effects related to obesity, such as breast cancer-related lymphedema (BCRL). The analysis explored outcome expectations for a weight lifting intervention by sedentary Black or White female breast cancer survivors and assessed the role of BCRL on outcome expectations for exercise. Chi-squared tests compared mean outcome expectation values for Black and White breast cancer survivors who completed baseline surveys for the Physical Activity and Lymphedema trial (n = 281). With race as the independent variable, multivariable analysis compared results for women without BCRL with those with BCRL, separately. Across the entire sample, Black survivors (n = 90) had significantly higher (p < 0.05) outcome expectations than White survivors (n = 191) for improvements in sleep, appearance, mental health, affect, energy, and eating habits, with small to moderate effect sizes. When stratified by BCRL status, differences by race were robust only among those with BCRL. Black cancer survivors had greater expectations than White cancer survivors for how a weight lifting intervention would improve their physical and mental states; these differences were most apparent among women with BCRL. Improving outcomes in Black breast cancer survivors rests on the development of interventions that are appropriately tailored to address the expectations of this population and account for differences in persistent adverse effects of cancer such as BCRL. Copyright © 2016 John Wiley & Sons, Ltd.

Abstract C20: Understanding disparities in cancer survivorship: Introducing the Cancer Survivorship in Metropolitan Detroit Cohort Study

Abstract Background: Recent successes in cancer diagnosis and treatment have led to improved survival overall; however, African-Americans (AA) continue to experience worse survival outcomes than whites for many cancers, and AA survivors in Detroit often experience poorer outcomes than those in other parts of the country. The reasons underlying these differing survivorship outcomes and disparities relative to white survivors are not clear. We have established the Cancer Survivorship in Metropolitan Detroit cohort study to evaluate potential contributors to disparities in outcomes including socioeconomic factors, health behaviors, social support, and comorbidities. Methods: AA and white adults (ages 20-79) seen at the Karmanos Cancer Institute and identified through the Metropolitan Detroit Cancer Surveillance System as having been diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013 are eligible to join the cohort. To date, 232 of the targeted 1,000 survivors have completed the self-administered online survey which collects information on demographic and socioeconomic characteristics, medical history, health behaviors, and social support. An interviewer-administered option is available to participants in need of assistance or without access to the Internet. Participants are also asked to consent to provide a saliva sample and access to medical records, and to participate in annual follow-up for up to four years. Data are available on both short-term outcomes such as quality of life and treatment, and long-term outcomes including cancer progression and recurrence and total and cancer-specific survival. Results: Of the first wave of participants contacted, 60% have completed the baseline questionnaire. The average age of participants is 62, 61% of initial respondents are AA and 66% are women. Overall, 30% of initial questionnaires have been completed online without assistance, including 46% completed by white survivors and 18% by AA survivors. Selected preliminary data suggest several differences between AA and white survivors in the cohort. The majority (62%) of white survivors reported household incomes of at least $40,000 compared with 18% of AA survivors (p&amp;lt;0.001). Relative to whites,fewer AA cancer survivors were married (21% vs 65%, p&amp;lt;0.001), or employed full time (11% vs. 24%, p=0.006) at baseline, and fewer owned or leased a vehicle (55% vs. 89%, p&amp;lt;0.001). A lower proportion of AA survivors (56%) had any form of private health insurance compared with whites (83%, p&amp;lt;0.001). AA survivors reported suffering from 3.3 comorbid conditions on average, compared with 2.7 among whites (p=0.014). A higher proportion of AA survivors reported that pain interfered with day-to-day activities (26% vs. 16%, p=0.06), while a higher proportion of whites reported high levels of fatigue (33% vs. 22%, p=0.06). A greater proportion of AA survivors reported current smoking (33% vs. 14%, p=0.005) and eating fast food regularly (46% vs. 25%, p=0.001), while a lower proportion participated in regular physical activity (24% vs. 42%, p=0.006). Alcohol and fruit and vegetable consumption were similar in white and AA survivors. Social support was also similar among the two groups, with a majority (75-80%) reporting usually or always having someone to help with chores, errands, or if they were confined to bed. Implications: These preliminary data suggest that AA and white cancer survivors in Detroit vary with regard to a number of health-related factors that may impact outcomes. These data can be used to further understand and address survival disparities and improve outcomes among AA cancer survivors, and may be instructive to other investigators implementing cohort studies among cancer survivors, particularly those wishing to incorporate online data collection. Citation Format: Theresa A. Hastert, Tara Baird, Julie J. Ruterbusch, Terrance L. Albrecht, Ann G. Schwartz, Jennifer L. Beebe-Dimmer. Understanding disparities in cancer survivorship: Introducing the Cancer Survivorship in Metropolitan Detroit Cohort Study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C20.

Abstract A19: A mixed methods approach to assessing ehealth activity among African American cancer survivors

Abstract The research literature on eHealth activity across different patient populations is rapidly expanding, yet little is known about eHealth among diverse cancer survivors. Most existing measures of such activity are quantitative (QUAN). Compared to qualitative (QUAL) methods, QUAN methods are limited in capturing in-depth information regarding eHealth experiences that can inform user-centered design of technologies optimized for survivors' use. The goal of the pilot project reported here was to develop a mixed methods approach to assessing the full scope of eHealth activity among African American cancer survivors. Based on a literature review, study investigators created a measure that included 27 eHealth activities across 5 domains: informational, communal, self-care/management, expert care, and transactional. An embedded mixed methods design was used in which QUAN items represented the “primary strand” of data and QUAL probes represented the “secondary strand.” Within each domain, participants responded to QUAN items regarding each activity that asked if they were aware the activity was possible; if they had ever engaged in the activity personally; whether someone else (surrogate) had engaged in the activity on their behalf; the recency of the eHealth activity; how often the activity was related to their cancer; and their interest in engaging in the activity in the future. Then, QUAL probes were presented asking about the reasons they had participated in domain-specific activities and general problems or challenges within activities, or what had kept them from engaging in the activities and the support/resources needed to do so in the future. Participants were 23 African American breast, prostate, and colorectal (CRC) cancer survivors (12 breast; 7 prostate; 2 female CRC; 1 male CRC) identified through the Metropolitan Detroit Cancer Surveillance System, a member of NCI's SEER program. The mean age among participants was 60 years and time since end of primary treatment ranged from 13-46 months. In this pilot sample, 78% reported using the internet. Personal engagement in eHealth activities was highest in the informational domain (range: 9-72% across items) and the most reported activity was searching online for information about specific symptoms or problems. Personal engagement was lowest in the transactional domain. Across both personal and surrogate engagement, eHealth activities most often reported as related to cancer most or all of the time were searching online for information about how to reduce healthcare costs (60%), searching online for information about a hospital or healthcare facility (62.5%), and using technology to track medical symptoms (100%). Across all participants, interest in future engagement was greatest in the informational domain, including searching online for information about specific symptoms (86%), medical treatments or procedures (78%), and signing up to receive online, email or mobile updates on medical issues (74%). Interest in the future engagement was lowest for the communal domain. QUAL probes revealed several challenges within eHealth activities including difficulties in identifying credible health-related online resources; verifying the credibility of online health information; determining effective search terms to find relevant information; managing different policies across healthcare providers related to the electronic exchange of information; and technical problems with devices. Findings led to the revision of this mixed methods approach such that additional QUAN items and QUAL probes were added, with QUAL probes specific to eHealth activities rather than eHealth domains . The revised measure is currently being administered as part of an AHRQ-funded R01 study of eHealth activity among 1200 African American and white cancer survivors in the metropolitan Detroit area. Citation Format: Hayley S. Thompson, Anne Katz, Charity Barnes, Mary Smith, Tara Eaton. A mixed methods approach to assessing ehealth activity among African American cancer survivors. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A19.

Abstract PR07: Racial and ethnic differences in dietary intake, physical activity, and body mass index (BMI) among cancer survivors: 2005 and 2010 National Health Interview Surveys (NHIS)

Abstract Background: Cancer survivors are at increased risk for developing secondary tumors and other comorbid conditions, such as cardiovascular disease, and a diminished health-related quality of life. Minority survivors have higher risk for recurrence and other comorbid conditions than non-Hispanic white survivors. Data are lacking regarding racial/ethnic differences in related health behaviors among cancer survivors. We investigated racial/ethnic differences in mean dietary and alcohol intake, physical activity, and BMI and adherence to American Cancer Society (ACS) and governmental recommendations, using data from the cross-sectional 2005 and 2010 NHIS. Methods: The sample included respondents with a history of cancer, excluding those with non-melanoma or unknown skin cancer and underweight or unknown BMI. The total sample (N=3367) included non-Hispanic Whites (NHW; N=2698), non-Hispanic Blacks (NHBs; N=379) and Hispanics (N=290). Age/sex adjusted ANOVA compared mean daily dietary intake of fruit and vegetables, fiber, added sugars, calcium, weekly moderate and vigorous physical activity and BMI between racial/ethnic groups. Age/sex adjusted predicted marginals compared prevalence of non-adherence with ACS and governmental guidelines for nutrition and physical activity and BMI status between racial/ethnic groups. Multivariate logistic regression was used to analyze associations of race/ethnicity with guideline non-adherence. Multivariate logistic regression adjusted for socio-demographic, smoking and BMI differences. Results: Hispanics had the highest mean intake of fruit and vegetables, fiber and calcium (p=.0031; p&amp;lt;.0001; p&amp;lt;.0001) and the lowest intake of added sugars (p=0.0392). NHBs had the highest mean BMI (30.1 kg/m2; p=&amp;lt;.0001). All racial/ethnic groups had high prevalence of non-adherence to fiber guidelines, with Hispanics having the lowest non-adherence (95.4% NHWs; 94.0% NHBs; 89.7% Hispanics; p=0.0025). NHWs had highest non-adherence with alcohol guidelines (4.8%, p=&amp;lt;.0001). 60.8% of NHWs, 72.9% of NHBs and 72.3% of Hispanics did not adhere to physical activity guidelines (p=&amp;lt;0.0001). 65.7% of NHWs, 76.3% of NHBs, and 75.0% Hispanics were overweight/obese (p=&amp;lt;.0001). In the logistic regression model adjusting for socio-demographic covariates, smoking and BMI, Hispanics had lower prevalence of non-adherence to added sugars guidelines (OR=0.68; CI=0.47-0.98) than NHWs and lower non-adherence to fiber guidelines (OR=0.45; CI=0.26-0.78). Differences in non-adherence to alcohol guidelines among Hispanics did not reach significance; however, NHBs had significantly lower non-adherence with alcohol guidelines than NHWs (OR=0.40; CI=0.19-0.82). Hispanics were 1.50 times more likely to not adhere to physical activity guidelines (CI=1.05-2.14). NHBs and Hispanics were 1.76 and 1.55 times, respectively, to be overweight/obese (CI=1.32-2.33 and CI=1.10-2.17). Conclusion: There are racial/ethnic differences in certain health behaviors. However, non-adherence to guidelines is high in all three racial/ethnic groups. Achieving the recommended guidelines for nutrition, physical activity and weight management is a concern for all cancer survivors, indicating the need for intervention among this growing group of at-risk individuals. This abstract is also presented as Poster B36. Citation Format: Doratha Armenthus Byrd, Tanya Agurs-Collins, David Berrigan, Francis Thompson. Racial and ethnic differences in dietary intake, physical activity, and body mass index (BMI) among cancer survivors: 2005 and 2010 National Health Interview Surveys (NHIS). [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr PR07.

Advancing breast cancer survivorship among African-American women.

Advances have occurred in breast cancer survivorship but, for many African-American women, challenges and gaps in relevant information remain. This article identifies opportunities to address disparities in breast cancer survival and quality of life, and thereby to increase breast cancer survivorship among African-American women. For breast cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, difficulty sleeping, and sexual dysfunction. For addressing physical and mental health concerns, a variety of interventions have been evaluated, including exercise and weight training, dietary interventions, yoga and mindfulness-based stress reduction, and support groups or group therapy. Obesity has been associated with breast cancer recurrence and poorer survival. Relative to white survivors, African-American breast cancer survivors are more likely to be obese and less likely to engage in physical activity, although exercise improves overall quality of life and cancer-related fatigue. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among breast cancer survivors, but few studies have focused specifically on African-American women with a breast cancer diagnosis. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to a breast cancer diagnosis. There is a need for a better understanding of breast cancer survivorship among African-American women. Additional evaluations of interventions for improving the quality of life and survival of African-American breast cancer survivors are desirable.

Racial and ethnic differences in health behaviors among cancer survivors.

Previous studies of health behaviors of adult cancer survivors have not adequately examined racial and ethnic differences because of small sample sizes. A national data set was used to examine differences in health behaviors between cancer survivors and controls and between racial and ethnic groups among survivors. The study analyzed 2009 Behavioral Risk Factor Surveillance System survey data in 2012-2014. Descriptive statistics were used to examine differences in health behaviors between cancer survivors and controls aged 20-64 years. Multivariable analysis was conducted to examine associations between race/ethnicity (white, African American, Hispanic, Asian, or Native American) and health behaviors (BMI, fruit and vegetable consumption, physical activity, and smoking status) while adjusting for demographic and medical characteristics. Significance was set at p<0.01. Compared with controls (n=245,283), cancer survivors (n=17,158) had higher prevalence rates for overweight/obese status (67% vs 65%); not meeting physical activity recommendations (53% vs 49%); and current smoking status (22% vs 20%). In the multivariable model, diet and smoking behavior differed across cancer status. African American (AOR=1.95) and Hispanic (AOR=2.06) survivors were more likely to have higher BMI than white survivors. African American survivors (AOR=1.6) were less likely to meet physical activity guidelines. Native American (AOR=3.08) and multiracial (AOR=1.74) survivors were more likely to be current smokers than non-Hispanic white survivors. This study suggests that racial and ethnic differences exist in the adoption of recommended health behaviors; future research should identify factors to reduce these differences.

The impact of age and race on longevity in pediatric astrocytic tumors: A population-based study.

Despite improvements in pediatric brain tumor outcomes, the survivors of childhood brain tumor are burdened by multiple comorbidities. This work reports on the relative survival ratios and excess mortality rate in children with astrocytic tumors over the past four decades. Survival analysis was conducted using flexible parametric model to estimate relative survival and excess mortality rate for non-white and white children (0-19 years old) using the Surveillance, Epidemiology & End Results (SEER) database. We incorporated age group and year of diagnosis into the model to estimate these indices for the period of 1973-2010. Progressive decline in relative survival ratios was noted over time. Non-white children had lower survival rates than white children, and these survival patterns persisted over the four-decade span of the study. Fifty percent of non-white survivors were deceased 30 years post diagnosis, compared to 35 years in white survivors. Survivors of childhood brain tumors have progressively lower survival rates as they get older, and this is higher in non-white when compared to white children. Future research efforts need to focus on understanding the factors mediating the effect of the tumor or its treatment on survival in these patients, and the ethnic variations that derive these survival trends.

Disparities in barriers to follow-up care between African American and White breast cancer survivors.

Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors. We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009-2011, 6-24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates. Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1-10.1). Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.

Is John Henryism a resilience factor in women experiencing intimate partner violence?

Background: Research suggests that posttraumatic stress disorder (PTSD) and depression are two common mental health problems in intimate partner violence (IPV) survivors. Research has found that while Black women consistently report higher rates of victimization than White women, they also report less severe PTSD and depressive symptoms, suggesting that Black IPV survivors might be more resilient to PTSD and depression than are White survivors. Design: We implemented a correlational study with 81 Black and 100 White female survivors of IPV to determine if John Henryism (JH; i.e., a predisposed active coping mechanism) contributes to the resilience observed in Black IPV survivors. Methods: Participants completed the John Henryism Active Coping Scale, Center for Epidemiological Studies Depression Scale, Davidson Trauma Scale, and the Abusive Behavior Inventory. Results: Results demonstrated that White woman endorsed more severe depressive symptoms as compared to Black women. Severity of PTSD symptoms and JH was not significantly different between races. JH did not moderate the relationship between race and depression; however, for PTSD, JH was found to be protective of PTSD in White women, while demonstrating little impact on Black women. Conclusions: The implications of these findings are discussed in terms of the minority stress model.